Drilling Down into Primary Assessment

Rescuers in Action: Rolling the victim should be done with the rescuers working in unison.

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Pete DeQuincy

Rescuers in Action: Rolling the victim should be done with the rescuers working in unison.

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Rescuers in Action: When checking for breathing and pulse in the cephalic position, remember to continue to look down the victim&#39;s chest.

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Pete DeQuincy

Rescuers in Action: When checking for breathing and pulse in the cephalic position, remember to continue to look down the victim's chest.

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Rescuers in Action: When checking for breathing and pulse in the cephalic position, remember to continue to look down the victim&#39;s chest.

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Pete DeQuincy

Rescuers in Action: When checking for breathing and pulse in the cephalic position, remember to continue to look down the victim's chest.

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Pete DeQuincy is an aquatic supervisor for the East Bay Regional Park District in Oakland, Calif. He is president of the Bay Area Public Pool Operators Association and the Aquatic Section of the California Parks & Recreation Society. DeQuincy is a lifeguard instructor for the American Red Cross and the United States Lifesaving Association.

Last February, I touched on a primary assessment drill. Here, we’ll break primary assessment into five drills using a single rescuer. Primary assessment can lead to caring for and monitoring an unconscious victim, dealing with severe bleeding, providing rescue breathing, or CPR. It includes:

Sound easy? It’s not! Primary assessment with a progression to the appropriate patient care should take under a minute. Also, most PA training is done in a quiet setting and several steps skimmed over verbally rather than done physically.

Speed and proficiency are mandatory for effective assessment. Train with these drills to get your team ready for the challenge. The rescuer’s personal safety is key, and a scene size-up with gloving up is the prequel to every primary assessment.

Gloving up during scene size-up drill: Have the team line up with gloves in hand. Objective: Each must have their gloves on in the time it takes to verbalize all components of a scene size-up. Scene size-up should be a scan including the following:

Check for environmental dangers.

Determine the number of victims.

Assess if more resources are needed.

Determine the cause of victim’s injury.

Assess if the victim should be extricated.

Depending on your agency, local protocols and training level, scene size-up could include if spinal precautions are needed.

This is all done before entering the scene and making contact with patient while simultaneously pulling gloves from a fanny pack and putting them on. Timing goal: 10-12 seconds to finish the objective with a trainer reciting the components.

Once proficient, move to variations:

Lifeguards start with gloves in their fanny packs (no change).

In verbal unison, guards recite the components of scene size-up while gloving up (15 seconds, then reduce to 10-12 seconds once proficient).

Body roll drill: Form teams of three: a primary rescuer, a secondary rescuer and a victim. Victim is on their side, rescuer(s) 5-10 feet away. Objective: Primary rescuer checks victim’s responsiveness, states, “No response,” body rolls victim to a supine position. Be careful with head, neck and back while rolling the victim. A secondary rescuer arrives. The primary rescuer tells the secondary rescuer to “activate EMS.” Timing goal: 5-7 seconds to finish objective.

Once proficient, move to variations:

Victim is in prone position (10 seconds).

Rescuers start with gloves on (no change).

Once victim is supine, rescuer takes lateral or cephalic position (no change).

Victim is prone; rescuers body roll them. Once victim is supine, secondary rescuer leaves to activate EMS and the primary moves to lateral or cephalic position on victim (5-7 seconds).

Airway maneuver progression drill: This drill was mentioned in Nov./Dec. 2013 and is integral to PA. Several variations have been modified to include quickly checking for breathing and pulse for no more than 10 seconds.) Pair the guards as rescuer and victim. Victim is supine on ground; rescuer, 5-10 feet away. Objective: Rescuer moves to victim’s lateral side; opens airway with head-tilt/chin-lift. Rescuer now can look, listen, feel for breathing. Timing goal: 5 seconds to finish objective. Once proficient, move to variations:

Rescuer in cephalic position does jaw-thrust with head extension (5 seconds).

Once the team is proficient in all the drills, link them together with the primary assessment combination drill: End goal is to do a sequence connecting all 4 drills into one fluid drill. First, combine two drills, then add more once the team shows proficiency. Objective: Rescuer(s) finish combined drills within the timing goals. To attain success, it will likely take several in-service trainings. Timing goal: The timing goal from each drill and variation should be added together; it varies depending on the drill combination (45-90 seconds).

Remember, practice builds skill, which in turn builds personal empowerment, elevating the rescuer to an aquatics professional. Train often, and with a passion.